重视自身免疫病相关性溃疡临床诊疗中的多学科协作

于家傲; 赵景春

doi:10.3760/cma.j.cn501120-20211112-00385

重视自身免疫病相关性溃疡临床诊疗中的多学科协作

doi: 10.3760/cma.j.cn501120-20211112-00385

于家傲^,,
赵景春

吉林大学第一医院烧伤外科，长春　　130021

基金项目:

吉林省科技发展计划重点研发项目 20200404166YY

吉林省卫生人才专项 JLSWSRCZX2020-002

吉林省科技发展计划项目 20200201615JC

详细信息

通讯作者:
于家傲，Email：yuja@jlu.edu.cn

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出版历程
- 收稿日期: 2021-11-12

Emphasis on multidisciplinary collaboration in clinical diagnosis and treatment of autoimmune disease-related ulcers

Yu Jia'ao^,,
Zhao Jingchun

Department of Burn Surgery, the First Hospital of Jilin University, Changchun 130021, China

Funds:

Key Research and Development Program of Scientific and Technological Development Project of Jilin Province of China 20200404166YY

Fund for Health Talents in Jilin Province of China JLSWSRCZX2020-002

Scientific and Technological Development Project of Jilin Province of China 20200201615JC

More Information

Corresponding author: Yu Jia'ao, Email: yuja@jlu.edu.cn

摘要

摘要: 自身免疫病的全球患病率和发病率呈逐年递增趋势，现已成为威胁人类健康的一类重大疾病。在该类疾病的进展中，持续、复杂的异常免疫反应常导致长期不愈的皮肤溃疡，不仅影响患者的生活质量，还可导致原发病的加重。因此，烧伤外科等创面修复学科的医师应加强对自身免疫病的认识，在治疗自身免疫病相关性溃疡时，建议根据疾病的发生发展规律，多学科协作，制订统一的治疗方案，以加速创面愈合、提高创面愈合质量。
- 自身免疫疾病 /
- 皮肤溃疡 /
- 伤口愈合 /
- 多学科诊疗
Abstract: The global prevalence and incidence of autoimmune diseases are increasing year by year, and the autoimmune diseases have become a major threat to public health. In the progression of the diseases, persistent and complex abnormal immune responses often lead to long-term unhealed skin ulcers, which not only affect the life quality of patients, but also lead to the aggravation of primary diseases. Therefore, doctors in burn surgery and other wound repair surgeries should pay attention to the understanding of autoimmune diseases. In the treatment of autoimmune disease-related ulcers, it is recommended to formulate a unified treatment plan according to the law of occurrence and development of the diseases, and multidisciplinary cooperation is needed to accelerate wound healing and improve the quality of wound healing.
- Autoimmune diseases /
- Skin ulcer /
- Wound healing /
- Multidisciplinary diagnosis and treatment
所有作者均声明不存在利益冲突

天疱疮是一种由针对桥粒芯蛋白（DSG）的自身抗体介导的自身免疫性水疱性疾病。研究显示，与单独使用糖皮质激素相比，应用利妥昔单抗（RTX）作为一线治疗药物能够使更多的天疱疮患者在停药后仍得到长期缓解。为了解RTX治疗天疱疮患者后介导长期临床缓解的免疫学机制，作者通过流式细胞法分析DSG特异性记忆B细胞和DSG特异性滤泡Th的表型，并通过酶联免疫斑点试验检测单独使用糖皮质激素或RTX治疗的患者的抗体分泌细胞水平。临床研究结果显示，RTX诱发了IgG类别转换的DSG特异性记忆B细胞的显著减少。因此，在应用RTX后完全缓解的患者中不能再检测到抗DSG抗体分泌细胞。相比之下，糖皮质激素并没有改变DSG特异性记忆B细胞的频率或表型，即使在症状缓解的患者中仍能够检测到抗DSG抗体分泌细胞。作者通过使用peptide-HLADRB1*0402 tetramer染色，得出在应用RTX后，DSG3特异性滤泡Th水平显著下降，而在糖皮质激素治疗后其能保持稳定。

故此研究结果表明，天疱疮对RTX的长期反应依赖于DSG特异性循环滤泡Th的减少，这与IgG类别转换的自身反应性记忆B细胞的持续消耗相关，会导致抗DSG抗体分泌细胞的消失。该研究证实RTX相较于糖皮质激素而言可以更有效地清除天疱疮患者DSG特异性自身反应性记忆B细胞。

张修航,编译自《J Invest Dermatol》,2021,141(9):2132-2140.e1;于家傲,审校

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